PROXY TO VOTE IN STOCKHOLDERS MEETING

KNOW ALL MEN BY THESE PRESENTS:

That I, _____________________, Filipino, of legal age, (single/married/widow), and a resident of __________________, Philippines, do hereby constitute and appoint _________Name of Proxy____________, who is also of legal age, Filipino, (single/married/widow), and a resident of _____________, Philippines, to represent me and vote the ________________________ (_________) shares of the capital stock appearing in my name at the Annual Stockholders Meeting of Name of Corporation, to be held on _________________.

IN WITNESS WHEREOF, I have hereunto set my hand this _____, day of ______, 20___, at the City of _______________, Philippines.

__________________________________________

STOCKHOLDER

Accepted by:

__________________________________________

PROXY

SIGNED IN THE PRESENCE OF: